Brewer v. Blackwell, 4-90-CV-30745.
| Citation | 836 F. Supp. 631 |
| Decision Date | 26 October 1993 |
| Docket Number | No. 4-90-CV-30745.,4-90-CV-30745. |
| Parties | Ronald W. BREWER, Plaintiff, v. Dr. Leonard BLACKWELL; Martha Van Baale; Dr. Martin E. Farbstein; and Correctional Medical Systems, Defendants. |
| Court | U.S. District Court — Southern District of Iowa |
Ronald W. Brewer, pro se.
Bruce C. McDonald of Dickey, Smith, Kultala & McDonald, Keokuk, IA, for defendants.
TABLE OF CONTENTS
I. INTRODUCTION AND BACKGROUND 633
II. FACTUAL FINDINGS 633
III. BREWER'S EIGHTH AMENDMENT DELIBERATE INDIFFERENCE
CLAIM
A. An Overview of the Eighth Amendment 637
B. Deliberate Indifference to a Serious Medical Need 637
1. Introduction 638
2. Deliberate Indifference — The Objective and Subjective Components 638
a. Introduction 639
b. The Objective Component 639
c. The Subjective Component 641
IV. ANALYSIS: INCLUDING FINDINGS OF ULTIMATE FACT 643
V. CONCLUSION 644
Plaintiff, Ronald W. Brewer is an inmate at the Iowa Mens Penitentiary ("ISP") in Fort Madison, Iowa. Brewer suffers from coronary artery disease. In this 42 U.S.C. § 1983 litigation, Brewer asserts that the failure of the Defendants to prescribe medications recommended by consulting physicians at the University of Iowa Hospital and Clinics constitutes deliberate indifference to his serious medical needs and therefore violates the Eighth Amendment's prohibition on cruel and unusual punishment. The Defendants are a Missouri corporation, two physicians licensed to practice medicine in Iowa, and a nurse each of whom provide medical care to inmates at ISP.
On December 31, 1990, Brewer commenced a pro se complaint against Dr. Leonard Blackwell and Martha Van Baale. On the same date, Judge Donald E. O'Brien issued an initial review order granting Plaintiff Brewer permission to proceed in forma pauperis pursuant to 28 U.S.C. § 1915(d), denying his application for a temporary restraining order, and appointing counsel to represent Brewer after consideration of the factors in In re Lane, 801 F.2d 1040, 1043-44 (8th Cir.1986). Counsel subsequently appeared on behalf of Brewer, engaged in rather extensive discovery and, on September 9, 1991, Chief Magistrate Judge Bremer granted Brewer's amendment to the complaint. The amendment added Dr. Farbstein and Correctional Medical Services ("CMS") as Defendants. The amended complaint alleges that the Defendants violated Brewer's Eighth Amendment rights by denying him medications recommended by the University of Iowa Hospitals & Clinics ("UIHC") on September 9, 1990 and again on July 1, 1991.
On January 25, 1993, Brewer's counsel was allowed to withdraw and Brewer proceeded pro se. After consenting to a United States magistrate judge pursuant to 28 U.S.C. § 636(c), this matter proceeded to trial on June 7, 1993. Brewer appeared pro se and the Defendants were represented by Bruce C. McDonald of Dickey, Smith, Kultala & McDonald, Keokuk, Iowa. The case was very well tried by both sides. Brewer was well prepared and his conduct during trial demonstrates that, through preparation and diligence, pro se inmate plaintiffs can adequately and effectively represent themselves.
Plaintiff, Ronald W. Brewer, is an inmate at the Iowa State Penitentiary ("ISP") and has been incarcerated in the Iowa State penal system for approximately thirty years. At all times relative to this litigation, Brewer has suffered from coronary artery disease. On May 9, 1989, Brewer was seen in the cardiology clinic of UIHC and received a diagnosis of "one vessel coronary artery disease, status post inferior myocardial infarction, one vessel coronary artery disease with occluded right coronary artery in 1988."
At all times material to this litigation Defendant CMS, a Missouri corporation, was under contract with the State of Iowa to provide medical services to inmates at ISP. CMS does not engage in the practice of medicine and exercised no control over the medical judgments, opinions, actions or decisions made by Drs. Blackwell and Farbstein regarding Brewer's medical care and treatment.
Dr. Martin E. Farbstein is a medical doctor licensed to practice in the State of Iowa and was the physician at ISP from April through October, 1991. On February 20, 1991, Dr. Farbstein entered into a written letter agreement with CMS to provide medical coverage at ISP. Dr. Farbstein was not employed by CMS but rather worked at ISP as an independent contractor for CMS.
Dr. Leonard Blackwell is a physician licensed by the State of Iowa. On October 27, 1988, he entered into an Independent Contract Physicians Agreement with ARA Health Services, Inc. d/b/a Correctional Medical Systems, Inc., a Missouri corporation, to provide medical services at ISP. Dr. Blackwell was not employed by CMS but rather worked at ISP as an independent contractor for CMS. Dr. Blackwell left ISP during the latter part of April, 1991.
In September, 1990, Defendant Martha Van Baale worked as a registered nurse at ISP. Van Baale had no authority to prescribe medications to Brewer. The record evidence does not indicate any affiliation between Van Baale and Defendant CMS.
During 1989, 1990 and 1991, Brewer's coronary artery disease was followed by Drs. Blackwell and Farbstein as well as consulting physicians at UIHC. On May 13, 1989, following an evaluation of Brewer in the cardiology clinic at UIHC, the consulting physician, Dr. Sanders, wrote Dr. Blackwell the following letter:
Brewer was again seen in the cardiology clinic of UIHC on September 10, 1990. On September 12, 1990, the UIHC consulting physician in the division of Cardiovascular Diseases, Dr. Weiss, wrote Dr. Blackwell the following letter concerning Brewer's follow-up visit:
Dr. Weiss was mistaken when he assumed Brewer was currently taking Diltiazem 60 mg four times per day.1 This reference to Brewer's medications in Dr. Weiss' September 12, 1990 correspondence to Dr. Blackwell was in error. Believing that Brewer was already taking 60 mg of Diltiazem four times per day, Dr. Weiss, in his September 12, 1990 letter to Dr. Blackwell, recommended an increase in Diltiazem to 90 mg four times per day. Dr. Weiss did not recommend an increase in any other of Brewer's medications.2
On September 18, 1990, after reviewing Dr. Weiss' recommendations, Dr. Blackwell entered the recommendations as orders for Brewer's prescriptions. Dr. Blackwell's prescription orders of September 18, 1990, in the ordinary course of procedures at the ISP Hospital, were sent to Steven Helling, the pharmacist at ISP. In reviewing Dr....
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